Telehealth in Managing Chronic Diseases: Diabetes and Hypertension

Posted: August 7th, 2024

Slide 1: Title Slide
Telehealth in Managing Chronic Diseases: Diabetes and Hypertension
Slide 2: Introduction and Research Problem
Telehealth has emerged as a promising approach for managing chronic diseases, particularly diabetes and hypertension. The rapid advancement of communication technologies has facilitated remote healthcare delivery, offering potential solutions to improve patient outcomes and reduce healthcare disparities. However, patient access to technology varies significantly, especially in underserved populations such as rural areas. Addressing this issue is crucial for enhancing health outcomes and ensuring equitable healthcare delivery.
Research problem: Variations in patient access to technology may limit the effectiveness of telehealth interventions for managing chronic diseases like diabetes and hypertension, potentially exacerbating healthcare disparities.
Slide 3: Research Question and Study Type
Research question: How effective are telehealth interventions compared to traditional care in managing diabetes and hypertension among diverse patient populations?
Study type: Quantitative research using randomized controlled trials (RCTs) is most appropriate for answering this question. RCTs allow for direct comparison between telehealth interventions and standard care, providing robust evidence on the effectiveness of telehealth approaches.
Slide 4: Middle-Range Theory Application
Dorothea Orem’s Self-Care Deficit Theory serves as an applicable middle-range theory for this research problem. The theory emphasizes patients’ ability to perform self-care activities and the role of nursing in supporting these efforts. Telehealth interventions align with this theory by empowering patients to manage their chronic conditions more effectively through remote monitoring and education.
Slide 5: Literature Review Overview
Four recent RCTs examined the effectiveness of various telehealth interventions for managing diabetes and hypertension. These studies explored different aspects of telehealth, including SMS-based monitoring, comprehensive telehealth programs, and video conferencing, providing insights into the potential benefits and limitations of these approaches.
Slide 6: Study 1 – SMS-Based Home BP Telemonitoring
Calderón-Anyosa et al. (2023) investigated the effectiveness of SMS-based home blood pressure telemonitoring in improving blood pressure control.
Key findings:

Significant reduction in diastolic blood pressure in the intervention group
No significant difference in systolic blood pressure changes
SMS-based telemonitoring proved effective in decreasing diastolic BP

Slide 7: Study 2 – Comprehensive Telehealth vs. Telemonitoring/Care Coordination
Crowley et al. (2022) compared comprehensive telehealth intervention with telemonitoring and care coordination for patients with poorly controlled type 2 diabetes.
Key findings:

Greater reduction in HbA1c levels in the comprehensive telehealth group
Improved self-efficacy, self-care, and diabetes-related distress in the comprehensive group
Comprehensive telehealth showed superior outcomes compared to simpler interventions

Slide 8: Study 3 – Telemedicine for T2DM in Obese Youth and Middle-Aged Patients
Yin et al. (2022) evaluated telemedicine management of diabetes in obese youth and middle-aged patients during the COVID-19 pandemic.
Key findings:

Decreased postprandial blood glucose, triglyceride, and LDL cholesterol levels in the intervention group
Significant reduction in BMI in the telemedicine group
Telemedicine proved effective in managing diabetes and associated health indicators

Slide 9: Study 4 – Home Blood Pressure Monitoring and Videoconferencing
Yatabe et al. (2021) explored the safety and effectiveness of telemedicine for managing hypertension in Japanese patients.
Key findings:

Lower systolic blood pressure in the telemedicine group after one year
Higher rate of controlled systolic blood pressure in the telemedicine group
Home BP monitoring and videoconferencing showed promise in improving BP control

Slide 10: Synthesis of Findings
The reviewed studies consistently demonstrate the effectiveness of telehealth interventions in managing diabetes and hypertension. Key benefits include:

Improved blood pressure control
Better glycemic management
Enhanced self-care and disease management skills
Potential for weight management in diabetic patients

However, variations in intervention types and study populations highlight the need for tailored approaches to maximize telehealth benefits.
Slide 11: Implications for Nursing Practice
Telehealth interventions offer significant potential for improving chronic disease management. Nurses can play a crucial role in:

Implementing and coordinating telehealth programs
Educating patients on using telehealth technologies
Providing remote support and monitoring
Adapting care plans based on telehealth data

Integrating telehealth into nursing practice may require additional training and support for healthcare providers.
Slide 12: Limitations and Future Research Directions
Limitations:

Relatively small sample sizes in some studies
Short follow-up periods in certain trials
Potential selection bias due to technology access and literacy

Future research should:

Conduct larger-scale, long-term studies
Investigate telehealth effectiveness in diverse populations, including rural and underserved communities
Explore strategies to overcome technology access barriers
Examine cost-effectiveness of various telehealth interventions

Slide 13: Conclusion
Telehealth interventions show promising results in managing chronic diseases like diabetes and hypertension. The studies reviewed demonstrate improvements in key health indicators and patient self-management skills. While challenges remain, particularly regarding technology access and adaptation, telehealth presents a valuable tool for enhancing chronic disease care. As technology continues to evolve, further research and implementation strategies will be crucial to maximize the benefits of telehealth in diverse healthcare settings.
Slide 14: References
Calderón-Anyosa, R., Tincopa, J. P., Raza, M., & Cárcamo, C. P. (2023). Randomized controlled trial of home telemonitoring of blood pressure with an adapted tensiometer with SMS Capability. European Journal of Investigation in Health, Psychology and Education, 13(2), 440-449. https://doi.org/10.3390/ejihpe13020033
Crowley, M. J., Tarkington, P. E., Bosworth, H. B., Jeffreys, A. S., Coffman, C. J., Maciejewski, M. L., … & Edelman, D. (2022). Effect of a comprehensive telehealth intervention vs telemonitoring and care coordination in patients with persistently poor type 2 diabetes control: A randomized clinical trial. JAMA Internal Medicine, 182(9), 943-952. https://doi.org/10.1001/jamainternmed.2022.2947
Yatabe, J., Yatabe, M. S., Okada, R., & Ichihara, A. (2021). Efficacy of telemedicine in hypertension care through home blood pressure monitoring and videoconferencing: Randomized controlled trial. JMIR Cardio, 5(2), e27347. https://doi.org/10.2196/27347
Yin, W., Liu, Y., Hu, H., Sun, J., Liu, Y., & Wang, Z. (2022). Telemedicine management of type 2 diabetes mellitus in obese and overweight young and middle-aged patients during COVID-19 outbreak: A single-center, prospective, randomized control study. PLoS One, 17(9), e0275251. https://doi.org/10.1371/journal.pone.0275251

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Develop a PowerPoint Presentation in regards to the issue of Advanced Practice: Telehealth in Managing Chronic Diseases: Diabetes and Hypertension.

This topic is important because patient access to technology varies significantly. Addressing this issue is crucial for improving health outcomes and reducing healthcare disparities, especially in underserved populations such as rural areas.

1. Identify a current research problem related to advanced nursing practice that is of interest to you. Include WHY this is a problem. (Limit response to no more than 3 sentences). Develop a research question to provide information about the research problem.

2. Based on your research question, do you believe it will best be answered by a qualitative or quantitative study ? Support your decision as to why you believe the answers would best be provided by the type of study you have chosen.

3. Select a middle-range theory and identify the application of nursing theories to your research problem.

Conduct a literature review ( PLEASE SEE Uploaded file with my literature review with 4 articles, and based on these articles, please create a PPT).

4. Based on your literature review answer the following questions:

If qualitative,

Identify the purpose of the study.

Briefly, describe the design of the study and explain why you think it is either appropriate or inappropriate to meet the purpose.

Identify ethical issues related to the study and how they were/were not addressed.

Identify the sampling method and recruitment strategy that was used.

Discuss whether sampling and recruitment were appropriate to the aims of the research.

Identify the data collection method(s) and discuss whether the method(s) is/are appropriate to the aims of the study.

Identify how the data was analyzed and discuss whether the method(s) of analysis is/are appropriate to the aims of the study.

Identify four (4) criteria by which the rigor of a qualitative project can be judged.

Discuss the rigor of this study using the four criteria. 

Briefly, describe the findings of the study and identify any limitations.

Use the information that you have gained from your critique of the study to discuss the

trustworthiness and applicability of the study. Include in your discussion any implications for the discipline of nursing.

If quantitative,

Identify the purpose and design of the study.

Explain what is meant by ‘blinding’ and ‘randomization’ and discuss how these were addressed in the design of the study.

Identify ethical issues related to the study and how they were/were not addressed.  

Explain the sampling method and the recruitment strategy was used.

Discuss how the sample size was determined – include in your discussion an explanation of terms used.

Briefly, outline how the data was collected and identify any data collection instrument(s).

Define the terms of validity and reliability, and discuss how the validity & reliability of the instruments were/were not addressed in this study and why this is important.

Outline how the data were analyzed.

Identify the statistics used and the level of measurement of the data described by each statistical test – include in your discussion an explanation of terms used.

Briefly, outline the findings and identify any limitations of the study.

Use the information that you have gained from your critique of the study to briefly discuss the trustworthiness and applicability of the study. Include in your discussion an explanation of the term statistical significance and name the tests of statistical significance used in this study.

Submission Instructions:

The presentation is original work and logically organized.

Follow current APA format including citation of references.

The PowerPoint presentation should include 10-15 slides which are clear and easy to read.

Speaker notes expand upon and clarify content on the slides.

Incorporate a minimum of 4 current (published within the last five years) scholarly journal articles or primary legal sources (statutes, court opinions) within your work.

Journal articles and books should be referenced according to the current APA style (the library has a copy of the APA Manual).

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Literature Review
Telehealth in Managing Chronic Diseases: Diabetes and Hypertension
NUR-611

Telehealth in Managing Chronic Diseases: Diabetes and Hypertension.
Telehealth is the method of healthcare delivery using communication technologies, including computers, tablets, smartphones, remote monitoring devices, and wearable technology. While the adoption of telemedicine has increased in recent years, its role in improving care provision during the coronavirus pandemic has cemented its place as an important channel to deliver vital services. Telehealth encompasses prescription management and adherence to the treatment regimen, physical examination, nutritional evaluation, and patient education. This topic is important for research as telemedicine has great potential to manage chronic diseases and, specifically, address glycemic control and weight management in youth and adults. Addressing this issue is crucial as it helps to improve the ability of patients to self-manage their conditions and provide more personalized, professional, and safe management, resulting in improved life quality. The purpose of this paper is to provide a literature review on four RCT studies investigating trends and perspectives of using telehealth to improve symptoms and manage hypertension and diabetes.
SMS-Based Home BP Telemonitoring
Purpose
The goal of research conducted by Calderón-Anyosa et al. (2023) is to determine whether an SMS-based home BP telemonitoring system is strong enough to improve symptoms of uncontrolled high BP and decrease BP in patients receiving main treatment in a primary care center.
Subjects
Authors involve 38 patients in this RCT. 68% of research subjects are females, and their mean age is 68 years (Calderón-Anyosa et al., 2023). Current study includes patients with uncontrolled hypertension; 19 persons receive follow-up control, while 19 subjects receive intervention.
Methodology
Experts apply quantitative research methodology and use RCT design. The intervention group is engaged in the telemonitoring system, while the control group is offered the usual management.
Results
Calderón-Anyosa et al. (2023) discover a significant difference in diastolic BP change (-1.2 [6.4] mmHg versus -7.2 [9.8] mmHg) for control and intervention groups. A significant reduction in diastolic BP and values is also observed in those subjects who use telemonitoring if compared to the control group. Therefore, home BP telemonitoring based on SMS delivery is effective in decreasing diastolic BP, particularly when working in collaboration with primary care facilities.
Telehealth Intervention Versus Telemonitoring and Care Coordination
Purpose
Unlike previous research that compares telemonitoring systems and usual management of BP, the study conducted by Crowley et al. (2022) investigates the effectiveness of two interventions such as (1) comprehensive telehealth and (2) a simple telehealth approach based on telemonitoring and care coordination to improve symptoms in people with persistently poorly controlled T2DM. Here, the goal is to compare comprehensive and simple telehealth interventions and highlight their effectiveness in improving health outcomes, including HbA1c levels in patients who have poorly controlled diabetes.
Subjects
Unlike previous research that includes 38 patients with uncontrolled hypertension, current research randomizes 200 adults (45 females and 155 males) with persistently poorly controlled T2DM. 101 participants are involved in comprehensive telehealth, and 99 persons are engaged in telemonitoring/care coordination. Their mean age is 57.8.
Methodology
Previous studies and current research apply quantitative research methodology with RCT design. Here, authors compare a comprehensive and simple telehealth intervention, consisting of care coordination and telemonitoring for T2DM.
Results
Current research supports findings of previous study despite the fact that authors discuss different medical conditions, they still highlight effectiveness of using telehealth intervention in chronically ill patients. Specifically, researchers reveal that changes in HbA1c constitute −1.59% (10.17% to 8.58%) in comprehensive group from baseline to 12 months. Moreover, at 12 months, those engaged in comprehensive telehealth, show greater improvements in self-effectiveness, self-care, and distress related to their diabetes diagnosis.
Telemedicine Management of T2DM in Obese Youth and Middle-Aged Patients
Purpose
The current research seeks to assess the effectiveness of telemedicine management of diabetes in obese youth and middle-aged patients with diabetes during the coronavirus crisis.
Subject
99 subjects are involved in research and complete the 6-month follow-up. 52 respondents are involved in the intervention group, and 47 individuals are involved in the control group. Their mean age is 47.
Methodology
Previous studies and current research apply quantitative research methodology with RCT design. Authors randomly assigned 52 patients to the intervention telemedicine group and 47 patients to the control group (traditional outpatient clinic appointment) (Yin et al., 2022).
Results
Unlike previous research highlighting that comprehensive telehealth show greater improvements in self-effectiveness, self-care, and distress related to diabetes diagnosis, current one states that the intervention group demonstrates a decrease in postprandial blood glucose, triglyceride, and LDL cholesterol level and significant reduction in BMI.
Home Blood Pressure Monitoring and Videoconferencing
Purpose
The research seeks to explore the safety and effectiveness of telemedicine for managing hypertension in Japanese patients.
Subject
Unlike previous research that involves obese patients with diabetes, the current study includes 99 patients with hypertension, 54% of whom have untreated conditions (Yatabe et al., 2021). 49 persons are allocated to telemedicine, and 50 subjects are allocated to usual care.
Methodology
Previous studies and current research apply quantitative research methodology with RCT design. Here, the authors compare the effectiveness of telemedicine (monitoring and videoconferencing) and usual care in improving BP control.
Results
Current research supports findings of Calderón-Anyosa et al. (2023) highlighting effectiveness of SMS-based home BP telemonitoring in decreasing diastolic BP and state that antihypertensive therapy through home BP telemonitoring and video conferencing helps to achieve better BP control.
Conclusion and Direction for Further Research
Telemonitoring is an effective patient management approach involving various information technologies for monitoring clients at a distance. Besides improving adherence to treatment, the telemonitoring system increases awareness of disease. Due to the low level of control among people with hypertension, health experts propose telemonitoring blood pressure at home, thus increasing the proportion of patients with controlled conditions. Besides hypertensive patients, diabetic patients affected during COVID-19 can improve their self-effectiveness and management ability through telehealth technology. In the future, the use of SMS-based home telemonitoring of BP will have to be expanded in rural areas, and health providers should evaluate the utilization of this technology for longer follow-ups and involve a larger sample size. As most of the reviewed studies involve small size, it is necessary to determine the advantages of telemedicine use in treating hypertension and poorly controlled diabetes on a larger scale. In addition, current studies provide a solid basis for developing individualized telemedicine management models for chronic conditions.

References
Calderón-Anyosa, R., Tincopa, J. P., Raza, M., & Cárcamo, C. P. (2023). Randomized
controlled trial of home telemonitoring of blood pressure with an adapted
tensiometer with SMS Capability. European Journal of Investigation in Health,
Psychology and Education, 13(2), 440-449. https://doi.org/10.3390/ejihpe13020033
Crowley, M. J., Tarkington, P. E., Bosworth, H. B., Jeffreys, A. S., Coffman, C. J.,
Maciejewski, M. L., … & Edelman, D. (2022). Effect of a comprehensive telehealth intervention vs telemonitoring and care coordination in patients with persistently poor type 2 diabetes control: A randomized clinical trial. JAMA Internal Medicine, 182(9), 943-952. https://doi.org/10.1001/jamainternmed.2022.2947
Yatabe, J., Yatabe, M. S., Okada, R., & Ichihara, A. (2021). Efficacy of telemedicine in
hypertension care through home blood pressure monitoring and videoconferencing: Randomized controlled trial. JMIR Cardio, 5(2), e27347. https://doi.org/10.2196/27347
Yin, W., Liu, Y., Hu, H., Sun, J., Liu, Y., & Wang, Z. (2022). Telemedicine management of
type 2 diabetes mellitus in obese and overweight young and middle-aged patients
during COVID-19 outbreak: A single-center, prospective, randomized control study.
PLoS One, 17(9), e0275251. https://doi.org/10.1371/journal.pone.0275251

Evidence Matrix
Name: Gurzhii Tetyana Date: 07/13/2024
Author Journal Name/ Year of Publication
Research Design Sample Size Outcome Variables Measured Quality (A, B, C)
Results/Author’s Suggested Conclusion
Calderón-Anyosa et al. European Journal of Investigation in Health, Psychology and Education/2023. Quantitative. RCT 38 The aim of the study is to assess how SMS-based home BP telemonitoring influences hypertensive patients and their symptoms (Calderón-Anyosa et al., 2023).
B Authors do not reveal a significant difference in systolic BP changes in control group (−7.2 [14.9] mmHg) and intervention group (−16.3 [16.7] mmHg). However, experts detect significant differences in diastolic BP changes (−1.2 [6.4] mmHg) for control group and −7.2 [9.8] mmHg for intervention group.
In conclusion, experts highlight the effectiveness of SMS-based home BP telemonitoring in decreasing diastolic BP. This intervention serves as an important alternative option for controlling BP in hypertensive patients.

Crowley et al. JAMA Internal Medicine/2022
Quantitative. RCT.
200
The aim of the study is to address gaps in clinical evidence that hinder the smooth utilization of telemedicine in poorly controlled T2DM by comparing simple and comprehensive telehealth interventions.

B From baseline to 12 months, changes in HbA1c constitute −1.59% (10.17% to 8.58%) in the comprehensive group and −0.98% (10.17% to 9.19%) in the telemonitoring group. At 12 months, clients involved in comprehensive telehealth show greater improvements in distress, self-effectiveness, and self-care related to diabetes diagnosis. If compared to the conventional treatment approach, comprehensive telehealth improves multiple medical outcomes in patients with poorly controlled diabetes (Crowley et al., 2022). Current research supports using comprehensive telehealth for assigned medical conditions in health systems with relevant

Yatabe et al.
JMIR Cardio/2021 Quantitative. RCT. 99 The objective of research is to examine safety and effectiveness of telemedicine for managing high blood pressure in Japanese patients. B
Baseline BP is similar in both control and intervention groups, but the level of systolic BP at the end of the first year of intervention is lower in telemedicine group (125, SD 9 mmHg versus 131, SD 12 mmHg). The rate of SBP (135 mmHg) is higher in telemedicine group (85.3% versus 70.0%) than in control group (Yatabe et al., 2021).
Antihypertension intervention through web-based visits and home telemonitoring helps to better control BP control if compared to traditional care. This safe alternative treatment requires further examination to reveal how offered interventions benefit patients with other chronic conditions.

Yin et al. PLoS One/2022. Quantitative. RCT. 120 The objective of the research is to estimate the effects of telemedicine management on obese youth and middle-aged people with T2DM during the coronavirus pandemic. B
On 22nd day, the level of fasting glucose in the intervention group decreased if compared to the control group (p < 0.05), and the self-rating depression scale of the control group significantly increased in comparison with the baseline value (p < 0.05). At the end of 3 months, the level of FBG and HbA1c in the intervention group decreases if compared to the control group (p < 0.01) (Yin et al., 2022). At the end of 3 and 6 months, patients in the intervention group show a lower BMI if compared to the control group (p < 0.01). Authors conclude that telemedicine is an effective strategy to regulate blood glucose, lose weight, and relieve depression in T2DM patients.